Columbia University College of Physicians and Surgeons, Columbia University, New York 10032, USA.
Columbia University College of Physicians and Surgeons, Columbia University, New York 10032, USA.
Lancet Diabetes Endocrinol. 2014 Feb;2(2):165-74. doi: 10.1016/S2213-8587(13)70183-9. Epub 2014 Feb 3.
Bariatric surgery is an effective and increasingly common treatment for severe obesity and its many comorbidities. The side-effects of bariatric surgery can include detrimental effects on bone and mineral metabolism. Bone disease in patients who have had bariatric surgery is affected by preoperative abnormalities in bone and mineral metabolism related to severe obesity. Changes that arise after bariatric surgery are specific to procedure type: the most pronounced abnormalities in calciotropic hormones and bone loss are noted after procedures that result in the most malabsorption. The most consistent site for bone loss after all bariatric procedures is at the hip. There are limitations of dual-energy x-ray absorptiometry technology in this population, including artefact introduced by adipose tissue itself. Bone loss after bariatric surgery is probably multifactorial. Proposed mechanisms include skeletal unloading, abnormalities in calciotropic hormones, and changes in gut hormones. Few data for fracture risk in the bariatric population are available, and this is a crucial area for additional research. Treatment should be geared toward correction of nutritional deficiencies and study of bone mineral density in high-risk patients. We explore the skeletal response to bariatric surgery, potential mechanisms for changes, and strategies for management.
减重手术是治疗严重肥胖及其多种合并症的有效且日益常见的方法。减重手术的副作用可能包括对骨骼和矿物质代谢产生不利影响。接受过减重手术的患者的骨骼疾病受与严重肥胖相关的术前骨骼和矿物质代谢异常的影响。减重手术后发生的变化特定于手术类型：导致吸收不良最严重的手术，其钙调节激素和骨丢失的异常最为明显。所有减重手术后，骨骼丢失最常见的部位是臀部。在这类人群中，双能 X 线吸收法检测技术存在局限性，包括脂肪组织本身引入的伪影。减重手术后的骨丢失可能是多因素的。提出的机制包括骨骼卸载、钙调节激素异常和肠道激素变化。关于肥胖人群的骨折风险，仅有少量数据，这是进一步研究的关键领域。治疗应针对纠正营养缺乏和高危患者的骨密度研究。我们探讨了对减重手术的骨骼反应、变化的潜在机制以及管理策略。
